Date post: | 10-Apr-2018 |
Category: |
Documents |
Upload: | jithesh-wayanad-v |
View: | 223 times |
Download: | 0 times |
of 68
8/8/2019 Beh Prob in Sch Children
1/68
Dr. V.Dr. V. JitheshJitheshAMCHSS - SCTIMST
8/8/2019 Beh Prob in Sch Children
2/68
When he was very young he was slow indevelopment. He didn't speak until he was
two years old, and even when he was olderhe had trouble answering a question. Hewould first silently mouth the words tohimself and then slowly answer out loud. His
teachers said he was dumb and would neverbe successful at anything.
8/8/2019 Beh Prob in Sch Children
3/68
His family moved to @@@@ where he attended a highschool called @@@. He was bored at the school. His
family next moved to @@@, but they wanted him to finishthe school year in @@@. He wanted to leave so badly thathe got a false paper from a doctor stating he had a lungcondition and must move to a dry climate. Then heconvinced the school to give him a certificate in Maths so
he could get into college. They complied because theywanted to get rid of him.
8/8/2019 Beh Prob in Sch Children
4/68
8/8/2019 Beh Prob in Sch Children
5/68
8/8/2019 Beh Prob in Sch Children
6/68
8/8/2019 Beh Prob in Sch Children
7/68
Dyslexia
8/8/2019 Beh Prob in Sch Children
8/68
Definition Dyslexia is difficulty with language.
People with dyslexia typically have
average to above average intelligence.They may have difficulty with reading,spelling, understanding language theyhear, or expressing themselves clearly inspeaking or in writing. An unexpectedgap exists between their potential forlearning and their school achievement.
8/8/2019 Beh Prob in Sch Children
9/68
Characteristics of Dyslexia
Slow Word Recall Average or Above Intelligence Beyond third grade continuing to reverse and invert
letters and transpose words More difficulty decoding nonsense words than content
words Difficulty decoding single words in isolation Difficulty with letter/sound relationships Confusing small words such as at for to, said for and,
does for goes. Transposes number sequences and arithmetic signs (+, -,
x, =) although math skills are typically a strength
8/8/2019 Beh Prob in Sch Children
10/68
May have difficulty learning to tell time Spelling is usually difficult, frequently spells
the same word differently in a single piece ofwriting
Frequently able to decode a word they cannotspell
Listening comprehension is usually a strength
and the student typically can comprehend atgrade level what he hears orally Poor grasp of abstract concepts Difficulty in telling or retelling a story
Difficulty with rhyming words
8/8/2019 Beh Prob in Sch Children
11/68
When he was six, his father gave him a compass. Hewas fascinated by the way the needle always pointed
north. This experience helped to create a greatcuriosity in him and had an impact on the rest of hislife.
Once a week his parents invited a poor medicalstudent, Max Talmey to eat with them. Max brought
science books to share with Albert, and they becamegood friends.
8/8/2019 Beh Prob in Sch Children
12/68
His Uncle Jakob was a strong influence in his life. Hegave Albert math books about algebra and geometry.
Uncle Jakob described algebra as "a merry science".He said algebra could be compared to hunting a littleanimal. You didn't know the name of the animal, soyou called it "x". Then when you finally caught theanimal you gave it the correct name. He made
learning fun for the boy and also provided a modelfor teaching that Albert would later use. In the futurehe would explain his theories by using examples oftrains, elevators, and ships.
8/8/2019 Beh Prob in Sch Children
13/68
Some Talented Dyslexics
Inventors/Engineers/Scientists:
Albert Einstein
Thomas Alva Edison
Alexander Graham Bell
Artists:
Leonardo da Vinci
Walt Disney
Military/Political Strategists: General George Patton
Winston Churchill
Woodrow Wilson
8/8/2019 Beh Prob in Sch Children
14/68
8/8/2019 Beh Prob in Sch Children
15/68
8/8/2019 Beh Prob in Sch Children
16/68
A 15 year old boy Difficulty sitting still in class and home
Runs around the room
Climbs on the furniture
Becomes restless when he is forced to sit
in a chair
Has difficulty for waiting his turn whenplaying with other children.
8/8/2019 Beh Prob in Sch Children
17/68
Attention DeficitHyperactivity Disorder
(ADHD)
8/8/2019 Beh Prob in Sch Children
18/68
ADHD is Poor attention span
Easy distractibility
Always restless, leaves seat, running,climbing
Careless mistakes
Biological, psychological and social
risk factors
8/8/2019 Beh Prob in Sch Children
19/68
ADHD in adolescents ADHD Continues in adolescence
and adulthood(50-70%)
-in adolescence more inattention and
impulsivity-not identified-HIDDEN MORBIDITY
8/8/2019 Beh Prob in Sch Children
20/68
Pattern of ADHD in adolescents in
our schools..
ADHD-17.4%
ADHD NOS-7.9%
Ref; Anil kumar TV,MKC Nair et al(2006) Development and validation of a visualexplanatory screening tool for identifying ADHD, a common mental healthproblem in adolescent school students
8/8/2019 Beh Prob in Sch Children
21/68
ADHD - Hyperactivity symptoms
Leaving Seat
Play increased
Motor.
Fidgets
Runs, Climbs
Talkative
Impulsivity
Awaiting Turn
Intrudes
Q? Blurts out
8/8/2019 Beh Prob in Sch Children
22/68
ADD- without hyperactivity
Poor attention to details
Lazy Oppositional unmotivated
Easily distracted
Careless mistakes
Not listening Difficulty in organizing
Forgetfulness and loosing things
Avoidance of sustained mental effort
Failing to finish academic works
independently
8/8/2019 Beh Prob in Sch Children
23/68
ADHD - Diagnostic criteria
A. Either 1 or 2
1. qAttention - u 6 symptoms x 6months
2. Hyperactivity Impulsivity - u 6 Sym. x 6 months
B. Onset < 7yrs
C. u 2 settings
D. Impairment Social, academic or occupational
E. Not due to . PDD, Schiz, Mood, Anxiety
8/8/2019 Beh Prob in Sch Children
24/68
Complications?
InjuryPoor school performance
comorbidity
CONDUCT DISORDER
ADDICTIONSubstance abuse
8/8/2019 Beh Prob in Sch Children
25/68
Treatment & Management
Evaluation
8/8/2019 Beh Prob in Sch Children
26/68
Treatment tips
Essentialinformation
ADHDis not the childs fault
Better outcome if calm and accepting
They need extra help to remain calmattentive
May continue into adulthood
8/8/2019 Beh Prob in Sch Children
27/68
Counseling of patientsandfamily
Encourage parents to give positivefeedback
Avoid punishment ! Parents to discuss with school
teachers
Minimise distractions
Sport or Physical activity->help torelease energy
Meet school psychologist/counselor
8/8/2019 Beh Prob in Sch Children
28/68
Role of teacher?
TEACHERS are the key persons
to identify and intervene
8/8/2019 Beh Prob in Sch Children
29/68
Tips for teachers To increase chance of following
instructions
Eye contact
Stand near
Soft voice
Be specific Short and clear directions
8/8/2019 Beh Prob in Sch Children
30/68
Tips for teachers Break into simple directions
Use visual cues
Give 10 seconds to respond
Check comprehension
Ask to repeat
Let the child ask Repeat direction in calm ,clear voice
8/8/2019 Beh Prob in Sch Children
31/68
Teaching techniques1. Break lessons into small parts,
2. Use variety of Teaching Learning
methods- listening, seeing, touching
3. Use verbal and non verbal methods
4. Vary activities-group works
5. Short assignmentwith frequentfeedbacks and reinforcement
8/8/2019 Beh Prob in Sch Children
32/68
Class room rules Place class room rules in prominent
places
Seating-close to teacher
Near model students
Not near windows
Good relation with parents
8/8/2019 Beh Prob in Sch Children
33/68
8/8/2019 Beh Prob in Sch Children
34/68
Drugs
Stimulants Methyl phenidate
Non stimulant - Atomoxetine
Anti depressant - Clonidine
8/8/2019 Beh Prob in Sch Children
35/68
Attention Deficit Hyperactivity DisorderADHD and
Conduct disorder (30.7%) Depression(10.3%)
Adjustment disorder(8.3%)
Reference: Indu P S ,Anil Kumar TV et al, Mental healthmorbidity and associated factors in children and adolescents
attending a Child and Adolescent Psychiatry Clinic, 2002.
8/8/2019 Beh Prob in Sch Children
36/68
Sadness
Depression
?
8/8/2019 Beh Prob in Sch Children
37/68
4-8%more in girls(2 times)
8/8/2019 Beh Prob in Sch Children
38/68
ASK.HOW THEY AREFEELING ?
8/8/2019 Beh Prob in Sch Children
39/68
screening
1.Mood q low or sad mood
2.Interest
qpleas
ure
1/2 x 2 weeks
8/8/2019 Beh Prob in Sch Children
40/68
Diagnostic criteria
Sleep -q (o)
Weight - q Appetite
Worthlessness &guilt
8/8/2019 Beh Prob in Sch Children
41/68
Diagnostic criteria Death wish or acts
Energy q- fatigue, libido
PMA q (Psychomotor activity)slowing ofmovement /speech
Concentration q C/o q memory
5/9 x 2 weeks
8/8/2019 Beh Prob in Sch Children
42/68
Diagnosis
1.Mood2.Interest3.Sleep4.Weight5.Worthlessness
6.Death wish7.Energy8.Psychomotor retardation9.Concentration
5/9 2 weeks
8/8/2019 Beh Prob in Sch Children
43/68
Complications of depression if
untreated are
Poor psycho social outcome
School failure
Recurrent depression
Substance use.(alcohol, smoking etc) Suicide
8/8/2019 Beh Prob in Sch Children
44/68
Indication for drugs are Patient not responding to psychological
treatment alone. Severe symptoms. Bipolar depression (children with history of
mania and depression).. Psychotic symptoms (Delusions and
hallucinations). Chronic recurrent depression
8/8/2019 Beh Prob in Sch Children
45/68
Treatment
Drugs.
Antidepressants
Fluoxetine 20 mg OD * 6 Months
8/8/2019 Beh Prob in Sch Children
46/68
Fluoxetin
Preparation Startingdose
Usual/dailydose
.eg.Prodep
Flunil
,
.capsule 20mg
liquid 20mg/5ml
5 mg 20 mg.
8/8/2019 Beh Prob in Sch Children
47/68
SertralinePreparation Startingdose
Usual/dailydose
.eg. Serta.Serlift
Tablets
50 mg
Children25mg.
Adolescents- 50 mg.
50 mg
8/8/2019 Beh Prob in Sch Children
48/68
When to Refer?
1. No improvement
2. High suicidal risk
3. Psychotic symptoms delusions/ hallucinations
4. Atypical features
5. Substance abuse
6. Need more intensive psychotherapy
Depression
8/8/2019 Beh Prob in Sch Children
49/68
Counseling
8/8/2019 Beh Prob in Sch Children
50/68
Counseling
C-confidentiality
O-open questions
U-unconditional
N-non judgemental
S-sincere
8/8/2019 Beh Prob in Sch Children
51/68
Counseling E-empathy
L-listening I-impartial
N-non verbal communication
G-guidance
8/8/2019 Beh Prob in Sch Children
52/68
Depression -Summary
Common
Disabling, fatal
Simple diagnosis
Simple treatment
Family involvement
8/8/2019 Beh Prob in Sch Children
53/68
Angry...
Assaultive
8/8/2019 Beh Prob in Sch Children
54/68
Conduct Disorder
C d t Di d th i t
8/8/2019 Beh Prob in Sch Children
55/68
Conduct Disorder the aggressive teen
Clinical features- ADDS
Aggression
Destruction
Deceitfulness/ theft
Serious violation of rules
8/8/2019 Beh Prob in Sch Children
56/68
CD-Clinical features ?
Excessive level of fighting or bullying
Cruelty to animals and other people
Severe destruction to property, firesetting
Stealing, repeated lying
Truancy from school, running awayfrom home and unusually frequenttemper tantrums
8/8/2019 Beh Prob in Sch Children
57/68
Complications ? School drop out
Antisocial behavior
Substance use
High-risk sexual behavior
8/8/2019 Beh Prob in Sch Children
58/68
Thelost lamb.
8/8/2019 Beh Prob in Sch Children
59/68
Treatment tipsEssential information for patient and family
Effective discipline
(Clear and consistent)
but not harsh.
Avoid punishment
8/8/2019 Beh Prob in Sch Children
60/68
Effective discipline - clear andconsistent, but not harsh, avoidphysicalpunishment
Alter the circumstancesresulting inproblem behavior
Recognize good, pro-social behavior
andreinforce by giving attention Set clear andfirmlimits, inform in
advance of the consequences,respondimmediately.
8/8/2019 Beh Prob in Sch Children
61/68
Counselingto patientandfamily
Alterthe circumstances
Recognize goodbehavior
Consistentdiscipline, setclearandfirm limits, inform inadvance oftheconsequences, immediate response.
Discusswith teachers
Seek help from relatives, friends,communityresources
8/8/2019 Beh Prob in Sch Children
62/68
ADHD vs CD
ADHDstruggles
to controlhimself
andto maintainfocus.
Conductdisorderstruggles
with everyone andis
againstthe societyand societalrules.
8/8/2019 Beh Prob in Sch Children
63/68
Mismanaging an aggressive
diso
bedient Child Using force
Ridiculing
Forcing students to admit lies anderrors
Demanding confession
8/8/2019 Beh Prob in Sch Children
64/68
Mismanaging an aggressive
diso
bedient Child
Confronting students over issues
Asking students why they act out
Punishing students
Making disapproving comments
8/8/2019 Beh Prob in Sch Children
65/68
90% of the success
8/8/2019 Beh Prob in Sch Children
66/68
90% of the successin leadership is
attributed to EI
8/8/2019 Beh Prob in Sch Children
67/68
8/8/2019 Beh Prob in Sch Children
68/68